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Find A Doctor Or Hospital In Your Network.
When you sign up for an HMO, your first step is to pick a primary are physican (PCP) to manage your care. You may already have a PCP, such as your family doctor. A child’s pediatrician and a woman’s OB/Gyn can also act as their PCP.
Your PCP will make sure you get the care you need, even when you see another doctor or go to the hospital. When you have a health issue, you’ll first go to your PCP.
You don't need a referral to see a specialist who is in the MT Blue Focus POSSM network. For specialists not in the network, your PCP will need to get a referral approved before your specialist visit.
The PCP will:
When the specialist’s office calls to arrange your visit, ask if they are in your plan’s network. If the specialist plans a lot of tests or procedures, ask if they have checked to make sure all are covered.
If you are getting ongoing treatment for a health issue, ask your PCP about a standing referral. It allows you to see your specialist without needing a new referral for each visit.
It’s your right to ask questions to make sure your doctors are using your HMO the right way. You’ll have higher costs if you see a provider who is not in your HMO’s network.
You can get more information about your HMO health plan at any time. Just log in or register for your member account, Blue Access for MembersSM. Visit the My Coverage tab to verify your coverage and identify your medical group and PCP.
Originally published August 18, 2015; Revised 2020
Blue Cross and Blue Shield of Montana, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
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